The Effect of Intermittent Fasting Combined with Ad Libitum Days on Adults’ Elevated Blood Pressure: A Systematic Review of Human Studies
,
Abstract
Background: Diets utilizing intermittent fasting as an alternative method to promote weight loss have grown in popularity. However, the efficacy of intermittent among elevated blood pressure remains unclear. This review systematically analyses studies investigating the effects of intermittent variations among elevated blood pressure on changes in systolic blood pressure and diastolic blood pressure. Changes in body weight, body mass index, waist circumference, and energy intake were assessed as a secondary objective.
Methods: The American Search Elite, CINAHL, Cochrane, MEDLINE, ProQuest, PubMed, Scopus, and grey literature databases were searched for articles investigating intermittent fasting with ad libitum among adults with elevated blood pressure from Jan 2010 to Jun 2022.
Results: Twelve studies met the eligibility criteria. Systolic and diastolic blood pressure generally decreased, between -2.0 to -0.04 mmHg and -3 to -0.01 mmHg, respectively. The body weight and body mass index reduced significantly (-2.85 to -0.09 kg and -1.05 to -0.03 kg/m2, respectively). The review found a waist circumference reduction of -0.67 to -0.21 cm and an energy intake reduction of -263.89 to -2.58 kcal.
Conclusion: Intermittent fasting reduces systolic and diastolic blood pressure in 2-24 wk while decreasing body weight, body mass index, and energy intake. However, needs 48 wk to reduce waist circumference. This implies that it is critical to perform intermittent fasting on elevated blood pressure before the development of high blood pressure as part of a program to prevent hypertension in adults.
1. Chobanian AV, Bakris GL, Black HR, et al (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA, 289 (19):2560-2572.
2. Wei F, Wei J, Yong W, et al (2021). Impact of Elevated Systolic Blood Pressure Levels on Mortality and Life Expectancy in Southeast Chinese Residents. Iran J Public Health, 50 (10): 1993-2001.
3. Zhou D, Xi B, Zhao M, et al (2018). Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep, 8 (1):9418.
4. Wi-Young S, Dai-Hyuk C (2010). The Association of Life Style with Hypertension in Korean Women. Iran J Public Health, 39(3):37-44.
5. Yano Y, Reis JP, Colangelo LA, et al (2018). Association of Blood Pressure Classification in Young Adults Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Cardiovascular Events Later in Life. JAMA, 320 (17):1774-1782.
6. Lee KY, Wan Ahmad WA, Low EV, et al(2017). Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study. PLoS One, 12 (9):e0184410.
7. Williams B, Mancia G, Spiering W, et al (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens, 36 (10):1953-2041.
8. Baharuddin D, Said MA, Abdul Majid H ( 2023). Protocol for intervention study in reducing elevated blood pressure through intermittent fasting. J Pak Med Assoc, 73(11):2171–2176.
9. Irwan AM, Kato M, Kitaoka K, et al (2016). Development of the salt-reduction and efficacy-maintenance program in Indonesia. Nurs Health Sci, 18 (4):519-532.
10. Su TT, Majid HA, Nahar AM, et al (2014). The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial. BMC Public Health, 14 Suppl 3 (Suppl 3):S4.
11. Kang J, Chang Y, Kim S, et al (2019). Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults. Atherosclerosis, 282:188-195.
12. Ghany R, Palacio A, Chen G, et al (2020). Patients with elevated blood pressure or stage 1 hypertension have structural heart disease. Blood Press Monit, 25 (4):178-183.
13. Kim S, Chang Y, Kang J, et al (2019). Relationship of the Blood Pressure Categories, as Defined by the ACC/AHA 2017 Blood Pressure Guidelines, and the Risk of Development of Cardiovascular Disease in Low-Risk Young Adults: Insights From a Retrospective Cohort of Young Adults. J Am Heart Assoc, 8 (11):e011946.
14. Nabipour S, Ayu Said M, Hussain Habil M (2014). Burden and nutritional deficiencies in opiate addiction- systematic review article. Iran J Public Health, 43 (8):1022-32.
15. Jamshed H, Beyl RA, Della Manna DL, et al (2019). Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients, 11 (6):1234.
16. Carter S, Clifton PM, Keogh JB (2019). The effect of intermittent compared with continuous energy restriction on glycaemic control in patients with type 2 diabetes: 24-month follow-up of a randomised noninferiority trial. Diabetes Res Clin Pract, 151:11-19.
17. Sutton EF, Beyl R, Early KS, et al (2018). Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes. Cell Metab, 27 (6):1212-1221.e3.
18. Andreyeva T, Long MW, Henderson KE, et al (2010). Trying to lose weight: diet strategies among Americans with overweight or obesity in 1996 and 2003. J Am Diet Assoc, 110 (4):535-542.
19. Trepanowski JF, Kroeger CM, Barnosky A, et al (2017). Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med, 177 (7):930-938.
20. Hoddy KK, Kroeger CM, Trepanowski JF, et al (2014). Meal timing during alternate day fasting: Impact on body weight and cardiovascular disease risk in obese adults. Obesity (Silver Spring), 22 (12):2524-31.
21. Bowen J, Brindal E, James-Martin G, et al (2018). Randomized Trial of a High Protein, Partial Meal Replacement Program with or without Alternate Day Fasting: Similar Effects on Weight Loss, Retention Status, Nutritional, Metabolic, and Behavioral Outcomes. Nutrients, 10 (9):1145.
22. Bhutani S, Klempel MC, Kroeger CM, et al (2013). Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans. Obesity (Silver Spring), 21 (7):1370-9.
23. Carter S, Clifton PM, Keogh JB (2018). Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial. JAMA Netw Open, 1 (3):e180756.
24. Fitzgerald KC, Vizthum D, Henry-Barron B, et al (2018). Effect of intermittent vs. daily calorie restriction on changes in weight and patient-reported outcomes in people with multiple sclerosis. Mult Scler Relat Disord, 23:33-39.
25. Washburn RL, Cox JE, Muhlestein JB, et al (2019). Pilot Study of Novel Intermittent Fasting Effects on Metabolomic and Trimethylamine N-oxide Changes During 24-hour Water-Only Fasting in the FEELGOOD Trial. Nutrients, 11 (2):246.
26. Erdem Y, Özkan G, Ulusoy Ş, et al (2018). The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension. J Am Soc Hypertens, 12 (1):42-49.
27. Methley AM, Campbell S, Chew-Graham C, et al (2014). PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res, 14:579.
28. Moher D, Liberati A, Tetzlaff J, Altman DG (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6 (7):e1000097.
29. Higgins JP, Altman DG, Gøtzsche PC, et al (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 343:d5928.
30. Wells GA, Shea B, O’Connell D, et al (2019) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf
31. Kucuk B, Berg RC (2022). Alternate day fasting on subjective feelings of appetite and body weight for adults with overweight or obesity: a systematic review. J Nutr Sci, 11:e94.
32. Jospe MR, Roy M, Brown RC, et al (2020). Intermittent fasting, Paleolithic, or Mediterranean diets in the real world: exploratory secondary analyses of a weight-loss trial that included choice of diet and exercise. Am J Clin Nutr, 111 (3):503-514.
33. Parvaresh A, Razavi R, Abbasi B, et al (2019). Modified alternate-day fasting vs. calorie restriction in the treatment of patients with metabolic syndrome: A randomized clinical trial. Complement Ther Med, 47:102187.
34. Conley M, Le Fevre L, Haywood C, et al (2018). Is two days of intermittent energy restriction per week a feasible weight loss approach in obese males? A randomised pilot study. Nutr Diet, 75 (1):65-72.
35. Teng NIMF, Shahar S, Rajab NF, et al (2013). Improvement of metabolic parameters in healthy older adult men following a fasting calorie restriction intervention. Aging Male, 16 (4):177-183.
36. Gabel K, Kroeger CM, Trepanowski JF, et al (2019). Differential Effects of Alternate-Day Fasting Versus Daily Calorie Restriction on Insulin Resistance. Obesity (Silver Spring), 27 (9):1443-1450.
37. Widhalm K, Pöppelmeyer C, Helk O (2017). The Effect of Alternate-Day Fasting (ADF) on Weight Loss, Metabolic Parameters and Psychological Characteristics. Aktuel Ernahrungsmed, 42 (3):188-192.
38. Li C, Ostermann T, Hardt M, et al (2013). Metabolic and psychological response to 7-day fasting in obese patients with and without metabolic syndrome. Forsch Komplementmed, 20 (6):413-420.
39. O'Driscoll T, Minty R, Poirier D, et al (2021). New obesity treatment: Fasting, exercise and low carb diet - The NOT-FED study. Can J Rural Med, 26 (2):55-60.
40. Lin S, Lima Oliveira M, Gabel K, et al (2021). Does the weight loss efficacy of alternate day fasting differ according to sex and menopausal status? Nutr Metab Cardiovasc Dis, 31 (2):641-649.
41. Kessler CS, Stange R, Schlenkermann M, et al (2018). A nonrandomized controlled clinical pilot trial on 8 wk of intermittent fasting (24 h/wk). Nutrition, 46:143-152.e2.
42. Faris MA, Jahrami H, BaHammam A, et al (2020). A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract, 165:108226.
43. Gavish B (2023). Visualization of the interplay between arterial properties and 24-hour ambulatory blood pressure during daytime and nighttime, for different age ranges. Hypertens Res, 46 (12):2754-2756.
44. Parr EB, Devlin BL, Lim KHC, et al (2020). Time-Restricted Eating as a Nutrition Strategy for Individuals with Type 2 Diabetes: A Feasibility Study. Nutrients, 12 (11): 3228.
45. Smith P, Fritschi L, Reid A, et al (2013). The relationship between shift work and body mass index among Canadian nurses. Appl Nurs Res, 26 (1):24-31.
46. Anton SD, Lee SA, Donahoo WT, et al (2019). The Effects of Time Restricted Feeding on Overweight, Older Adults: A Pilot Study. Nutrients, 11 (7):1500.
47. Martínez-Rodríguez A, Rubio-Arias JA, García-De Frutos JM, et al (2021). Effect of High-Intensity Interval Training and Intermittent Fasting on Body Composition and Physical Performance in Active Women. Int J Environ Res Public Health, 18 (12): 6431.
48. Litwin M, Kułaga Z (2021). Obesity, metabolic syndrome, and primary hypertension. Pediatr Nephrol, 36 (4):825-837.
49. Cooke MB, Deasy W, Ritenis EJ, et al (2022). Effects of Intermittent Energy Restriction Alone and in Combination with Sprint Interval Training on Body Composition and Cardiometabolic Biomarkers in Individuals with Overweight and Obesity. Int J Environ Res Public Health, 19 (13): 7969.
50. Stenvinkel P (2015). Obesity--a disease with many aetiologies disguised in the same oversized phenotype: has the overeating theory failed? Nephrol Dial Transplant, 30 (10):1656-64.
51. Ludwig DS, Aronne LJ, Astrup A, et al (2021). The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr, 114 (6):1873-1885.
52. Anton SD, Moehl K, Donahoo WT, et al (2018). Flipping the metabolic switch: understanding and applying the health benefits of fasting. Obesity (Silver Spring), 26 (2):254-268.
2. Wei F, Wei J, Yong W, et al (2021). Impact of Elevated Systolic Blood Pressure Levels on Mortality and Life Expectancy in Southeast Chinese Residents. Iran J Public Health, 50 (10): 1993-2001.
3. Zhou D, Xi B, Zhao M, et al (2018). Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep, 8 (1):9418.
4. Wi-Young S, Dai-Hyuk C (2010). The Association of Life Style with Hypertension in Korean Women. Iran J Public Health, 39(3):37-44.
5. Yano Y, Reis JP, Colangelo LA, et al (2018). Association of Blood Pressure Classification in Young Adults Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Cardiovascular Events Later in Life. JAMA, 320 (17):1774-1782.
6. Lee KY, Wan Ahmad WA, Low EV, et al(2017). Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study. PLoS One, 12 (9):e0184410.
7. Williams B, Mancia G, Spiering W, et al (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens, 36 (10):1953-2041.
8. Baharuddin D, Said MA, Abdul Majid H ( 2023). Protocol for intervention study in reducing elevated blood pressure through intermittent fasting. J Pak Med Assoc, 73(11):2171–2176.
9. Irwan AM, Kato M, Kitaoka K, et al (2016). Development of the salt-reduction and efficacy-maintenance program in Indonesia. Nurs Health Sci, 18 (4):519-532.
10. Su TT, Majid HA, Nahar AM, et al (2014). The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial. BMC Public Health, 14 Suppl 3 (Suppl 3):S4.
11. Kang J, Chang Y, Kim S, et al (2019). Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults. Atherosclerosis, 282:188-195.
12. Ghany R, Palacio A, Chen G, et al (2020). Patients with elevated blood pressure or stage 1 hypertension have structural heart disease. Blood Press Monit, 25 (4):178-183.
13. Kim S, Chang Y, Kang J, et al (2019). Relationship of the Blood Pressure Categories, as Defined by the ACC/AHA 2017 Blood Pressure Guidelines, and the Risk of Development of Cardiovascular Disease in Low-Risk Young Adults: Insights From a Retrospective Cohort of Young Adults. J Am Heart Assoc, 8 (11):e011946.
14. Nabipour S, Ayu Said M, Hussain Habil M (2014). Burden and nutritional deficiencies in opiate addiction- systematic review article. Iran J Public Health, 43 (8):1022-32.
15. Jamshed H, Beyl RA, Della Manna DL, et al (2019). Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients, 11 (6):1234.
16. Carter S, Clifton PM, Keogh JB (2019). The effect of intermittent compared with continuous energy restriction on glycaemic control in patients with type 2 diabetes: 24-month follow-up of a randomised noninferiority trial. Diabetes Res Clin Pract, 151:11-19.
17. Sutton EF, Beyl R, Early KS, et al (2018). Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes. Cell Metab, 27 (6):1212-1221.e3.
18. Andreyeva T, Long MW, Henderson KE, et al (2010). Trying to lose weight: diet strategies among Americans with overweight or obesity in 1996 and 2003. J Am Diet Assoc, 110 (4):535-542.
19. Trepanowski JF, Kroeger CM, Barnosky A, et al (2017). Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med, 177 (7):930-938.
20. Hoddy KK, Kroeger CM, Trepanowski JF, et al (2014). Meal timing during alternate day fasting: Impact on body weight and cardiovascular disease risk in obese adults. Obesity (Silver Spring), 22 (12):2524-31.
21. Bowen J, Brindal E, James-Martin G, et al (2018). Randomized Trial of a High Protein, Partial Meal Replacement Program with or without Alternate Day Fasting: Similar Effects on Weight Loss, Retention Status, Nutritional, Metabolic, and Behavioral Outcomes. Nutrients, 10 (9):1145.
22. Bhutani S, Klempel MC, Kroeger CM, et al (2013). Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans. Obesity (Silver Spring), 21 (7):1370-9.
23. Carter S, Clifton PM, Keogh JB (2018). Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial. JAMA Netw Open, 1 (3):e180756.
24. Fitzgerald KC, Vizthum D, Henry-Barron B, et al (2018). Effect of intermittent vs. daily calorie restriction on changes in weight and patient-reported outcomes in people with multiple sclerosis. Mult Scler Relat Disord, 23:33-39.
25. Washburn RL, Cox JE, Muhlestein JB, et al (2019). Pilot Study of Novel Intermittent Fasting Effects on Metabolomic and Trimethylamine N-oxide Changes During 24-hour Water-Only Fasting in the FEELGOOD Trial. Nutrients, 11 (2):246.
26. Erdem Y, Özkan G, Ulusoy Ş, et al (2018). The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension. J Am Soc Hypertens, 12 (1):42-49.
27. Methley AM, Campbell S, Chew-Graham C, et al (2014). PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res, 14:579.
28. Moher D, Liberati A, Tetzlaff J, Altman DG (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6 (7):e1000097.
29. Higgins JP, Altman DG, Gøtzsche PC, et al (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 343:d5928.
30. Wells GA, Shea B, O’Connell D, et al (2019) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf
31. Kucuk B, Berg RC (2022). Alternate day fasting on subjective feelings of appetite and body weight for adults with overweight or obesity: a systematic review. J Nutr Sci, 11:e94.
32. Jospe MR, Roy M, Brown RC, et al (2020). Intermittent fasting, Paleolithic, or Mediterranean diets in the real world: exploratory secondary analyses of a weight-loss trial that included choice of diet and exercise. Am J Clin Nutr, 111 (3):503-514.
33. Parvaresh A, Razavi R, Abbasi B, et al (2019). Modified alternate-day fasting vs. calorie restriction in the treatment of patients with metabolic syndrome: A randomized clinical trial. Complement Ther Med, 47:102187.
34. Conley M, Le Fevre L, Haywood C, et al (2018). Is two days of intermittent energy restriction per week a feasible weight loss approach in obese males? A randomised pilot study. Nutr Diet, 75 (1):65-72.
35. Teng NIMF, Shahar S, Rajab NF, et al (2013). Improvement of metabolic parameters in healthy older adult men following a fasting calorie restriction intervention. Aging Male, 16 (4):177-183.
36. Gabel K, Kroeger CM, Trepanowski JF, et al (2019). Differential Effects of Alternate-Day Fasting Versus Daily Calorie Restriction on Insulin Resistance. Obesity (Silver Spring), 27 (9):1443-1450.
37. Widhalm K, Pöppelmeyer C, Helk O (2017). The Effect of Alternate-Day Fasting (ADF) on Weight Loss, Metabolic Parameters and Psychological Characteristics. Aktuel Ernahrungsmed, 42 (3):188-192.
38. Li C, Ostermann T, Hardt M, et al (2013). Metabolic and psychological response to 7-day fasting in obese patients with and without metabolic syndrome. Forsch Komplementmed, 20 (6):413-420.
39. O'Driscoll T, Minty R, Poirier D, et al (2021). New obesity treatment: Fasting, exercise and low carb diet - The NOT-FED study. Can J Rural Med, 26 (2):55-60.
40. Lin S, Lima Oliveira M, Gabel K, et al (2021). Does the weight loss efficacy of alternate day fasting differ according to sex and menopausal status? Nutr Metab Cardiovasc Dis, 31 (2):641-649.
41. Kessler CS, Stange R, Schlenkermann M, et al (2018). A nonrandomized controlled clinical pilot trial on 8 wk of intermittent fasting (24 h/wk). Nutrition, 46:143-152.e2.
42. Faris MA, Jahrami H, BaHammam A, et al (2020). A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract, 165:108226.
43. Gavish B (2023). Visualization of the interplay between arterial properties and 24-hour ambulatory blood pressure during daytime and nighttime, for different age ranges. Hypertens Res, 46 (12):2754-2756.
44. Parr EB, Devlin BL, Lim KHC, et al (2020). Time-Restricted Eating as a Nutrition Strategy for Individuals with Type 2 Diabetes: A Feasibility Study. Nutrients, 12 (11): 3228.
45. Smith P, Fritschi L, Reid A, et al (2013). The relationship between shift work and body mass index among Canadian nurses. Appl Nurs Res, 26 (1):24-31.
46. Anton SD, Lee SA, Donahoo WT, et al (2019). The Effects of Time Restricted Feeding on Overweight, Older Adults: A Pilot Study. Nutrients, 11 (7):1500.
47. Martínez-Rodríguez A, Rubio-Arias JA, García-De Frutos JM, et al (2021). Effect of High-Intensity Interval Training and Intermittent Fasting on Body Composition and Physical Performance in Active Women. Int J Environ Res Public Health, 18 (12): 6431.
48. Litwin M, Kułaga Z (2021). Obesity, metabolic syndrome, and primary hypertension. Pediatr Nephrol, 36 (4):825-837.
49. Cooke MB, Deasy W, Ritenis EJ, et al (2022). Effects of Intermittent Energy Restriction Alone and in Combination with Sprint Interval Training on Body Composition and Cardiometabolic Biomarkers in Individuals with Overweight and Obesity. Int J Environ Res Public Health, 19 (13): 7969.
50. Stenvinkel P (2015). Obesity--a disease with many aetiologies disguised in the same oversized phenotype: has the overeating theory failed? Nephrol Dial Transplant, 30 (10):1656-64.
51. Ludwig DS, Aronne LJ, Astrup A, et al (2021). The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr, 114 (6):1873-1885.
52. Anton SD, Moehl K, Donahoo WT, et al (2018). Flipping the metabolic switch: understanding and applying the health benefits of fasting. Obesity (Silver Spring), 26 (2):254-268.
| Files | ||
| Issue | Vol 54 No 2 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Intermittent fasting Blood pressure Weight loss Body mass index Waist circumference Adult | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Baharuddin D, Said MA, Abdul Majid H. The Effect of Intermittent Fasting Combined with Ad Libitum Days on Adults’ Elevated Blood Pressure: A Systematic Review of Human Studies. Iran J Public Health. 2025;54(2):273-284.
